Background: Religious/spiritual coping, that is, how individuals use religion/spirituality to deal with a stressor like a chronic illness, has been associated with improved physical and psychological outcomes in adults, but little is known about religious/spiritual coping in adolescents with a chronic illness, such as asthma. Objectives: As a clinical health psychologist interested in spirituality and coping in adolescents with chronic illness, the specific objectives for this award are to: a) enhance my skills in measurement development and research methodology to assess effectively the relationships between religious/spiritual factors and health outcomes for adolescents, b) validate 2 widely-used adult spirituality measures for use in adolescents, and c) develop and pilot test a spiritually-based intervention to assess feasibility of use in adolescents with a chronic illness. Training: For my career development, I plan to take further training in specific qualitative and quantitative methods, data analysis, and manuscript/grant preparation. Training activities will also include coursework, mentored secondary data analyses, and clinical work. My mentorship team is comprised of leading experts in the fields of spirituality, health-related quality of life, adolescent medicine, chronic illness, and research methodology: Joel Tsevat, MD, MPH (primary co-sponsor), Susan Rosenthal, PhD (co-sponsor), Maria Britto, MD, MPH, Kenneth Pargament, PhD, and Paul Succop, PhD. Research Design/Methods: The research plan consists of 3 projects involving a total of 165 adolescent outpatients with asthma. Project 1 is a qualitative study with 25 adolescents using semi-structured interviews to determine: a) whether 2 widely-used adult spirituality measures are understandable by adolescents, b) the range and depth of religious/spiritual coping strategies used, and c) why adolescents use religious/spiritual coping strategies. Project 2 is a quantitative prospective study with 115 adolescents using questionnaires to: a) assess the psychometric properties of 2 adult spirituality measures utilizing exploratory factor analysis and other statistical techniques, and b) examine the cross-sectional and longitudinal relationships among religiosity/spirituality, religious/spiritual coping, and health outcomes (i.e., health-related quality of life, depression/anxiety), and use structural equation modeling to assess moderating variables (e.g., developmental stage/age) and potential mediating pathways (e.g., social support). Project 3 is a pilot feasibility study with 25 adolescents to examine whether a spiritually-based intervention developed from findings from Projects 1 and 2 is feasible for use in adolescents with asthma. Findings will inform an R01 application of a longitudinal randomized controlled trial comparing a spiritually-based intervention versus a standard psychosocial intervention to improve health outcomes in adolescents with chronic illness.